腹腔镜与开腹建立犬胆道梗阻模型的对比研究  

A Comparative Study Between Laparoscopy and Laparotomy in Establishing Biliary Obstruction Model in Dogs

作　　者：薛飞[1] 吕毅[1] 虢宏昌 马锋[1] 严小鹏[1] 李建鹏[1] 徐向华[1] 陆建文[1] 董鼎辉[1] 朱皓阳 白纪刚[1] 李建辉[1] 刘亚雄[2] 

机构地区：[1]西安交通大学第一附属医院肝胆外科,西安710061 [2]西安交通大学机械制造系统工程国家重点实验室,西安710049

出　　处：《中国微创外科杂志》2015年第8期729-733,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：国家自然科学基金科学仪器专项(81127005);国家自然科学基金资助项目(51275387)

摘　　要：目的探讨腹腔镜建造犬胆道梗阻模型的可行性及其与开腹方式相比的优越性。方法将16只本地健康杂种犬随机分为2组,每组8只,分别行腹腔镜或开腹胆总管结扎术,比较2组手术时间、术后并发症、术后麻醉复苏、术后胃肠道恢复情况,以及术前、术后不同时间点白细胞、C反应蛋白(C-reactive protein,CRP)及血清降钙素原(procalcitonin,PCT)水平,术后10天进行大体观粘连Nair分级并取组织行病理学观察。结果与开腹组相比,腹腔镜组手术时间短[(39.6±3.1)min vs.(69.4±8.6)min,t=-9.183,P=0.001],麻醉苏醒早[(58.8±10.9)min vs.(92.4±13.9)min,t=-5.380,P=0.001],术后首次自主进食早[(3.6±0.6)h vs.(6.8±1.1)h,t=-7.439,P=0.001],首次排便早[(1.0±0.0)d vs.(1.9±0.6)d,t=-3.862,P=0.006],各时点白细胞、CRP、粘连指数Nair评分、结扎部位胆道组织病理学分级,腹腔镜组均优于开腹组且具有统计学意义(P<0.05),各时间点PCT、肝功能、胆红素水平2组差异无显著性(P>0.05)。结论腹腔镜建造犬胆道梗阻模型是一种微创、简便的方式,炎症水平及腹腔粘连程度较低,有利于二次手术和进一步实验研究。Objective To explore the feasibility of using laparoscopic technique to create animal model of biliary occlusion and its advantages as compared to laparotomy. Methods Sixteen local mongrel dogs were randomly divided into two groups with 8 dogs in each group. One group was given laparoscopic common bile duct ligation and the other group underwent laparotomy. The operation time, postoperative complications, anesthesia recovery time, gastrointestinal tract recovery condition, and the leucocyte, C- reactive protein （CRP） and procalcitonin （PCT） before and after operations were tested in different time points between the two groups. The histological features of ligation parts and the level of intraperitoneal adhesion （Nair score） were examined 10 days after operation. Results As compared to the laparotomy group, the laparoscopy group had significant shorter operation time [ （39.6 ± 3.1） min vs. （69.4±8.6） min, t= -9. 183, P=0.001], shorter anesthesia recovery time [（58.8 ±10.9） min vs. （92.4 ± 13.9） rain, t= -5.380, P=0. 001], earlier first eating time [（3.6±0.6） h vs. （6.8 ±1.1） h, t= -7.439, P=0.001], and earlier first defecation time [（1.0±0.0） d vs. （1.9±0.6） d, t= -3.862, P=0.006]. The leucocyte counts and CRPlevels of different time points, adhesion index （ Nair score） , and histological grading of ligated bile duct in the laparoscopy group were superior to those in the laparotomy group （P 〈 0.05）. There were no significant differences in liver functions, serum PCT, and bilirubin value at different time points between the two groups （P 〉 0. 05）. Conclusions Laparoscopic biliary occlusion is a simple and minimal invasive way to establish animal models. The technique is helpful to second operation and further study because of its lower inflammation rate and abdominal adhesion extent.

关 键 词：腹腔镜 开腹手术 胆道梗阻 动物模型 

分 类 号：R575.7[医药卫生—消化系统] R-332[医药卫生—内科学]